Archive for the ‘Health Care’ Category

I had prepared myself for what I perceived to be the inevitable striking down of the Individual Mandate and most likely the whole Affordable Care Act along with it. I believed that it would be struck down for two reasons:

First, because it’s a conservative court deciding on a very political issue during an election year.

Second, because I did question whether an individual mandate is constitutional.

In truth, I’m not the biggest fan of the Affordable Care Act. Despite the conservative propaganda, it’s actually a huge compromise for liberals. Many of us believe that a single payer program is the only true solution, and while this law makes some very beneficial changes, it ultimately staves off the type of reform I believe would truly fix the problem.

The Affordable Care Act borrows many Republican ideas (it’s modeled after “Romneycare”) and excludes many key liberal ideas (such as the public option) in an attempt to win some bipartisan support. This strategy backfired; however, and Republicans reject it and characterize it as a government take-over. So what I’m trying to say is that I would have preferred that we actually did a government take-over, especially since we’re being blamed for one anyway.

Nevertheless, I’m happy it was upheld for two reasons:

First, because a conservative Justice ruled against his own party on a very politically charged bill. It’s given me some hope that at least one branch of government can make non-partisan decisions. Granted, it was a 5 to 4 vote, so it was mostly partisan. And I will concede that it would be difficult for me to be as gleeful about it had a democratically controlled court ruled against the law.

Second, I’m glad it was upheld because now I feel very comfortable with the constitutionality of the law. Justice Roberts characterizes the Individual Mandate as a tax, and it is within the government’s power to tax for not purchasing insurance.   He did clarify that a person cannot be jailed for not paying the tax, so it’s not really a mandate when you think about it. I guess the decision wasn’t so difficult when you look at it that way.

Republicans also have reason to be happy. For one, the court did strike down the Federal mandate to extend Medicaid benefits. It’s unfortunate for the poor people who would have benefited, but the provision was problematic for many States’ budgets. In Colorado, we were having to take money from education, which also benefits the poor, in order to meet this requirement.

Republicans should also be glad that the individual mandate was upheld because the Paul Ryan Medicare reform will require it.

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So yesterday I saw a flurry of activity on my Facebook news feed which I thought was unusual.  The usually heavily loved and supported Susan G. Komen for the Cure was being lambasted by many people after news spread that it was pulling grant funds from Planned Parenthood that had been targeted towards cancer screenings.  Many people were sad about the development, and saying, “shame, shame on you” Komen, intimating that this was grievously putting women’s health at risk.  And not only that they were putting women’s health at risk, but they were doing it on implied orders from the VRW (vast right wing) and religious right as a means to try and defund PP – them being the largest providers of abortions in the U.S.

I proceeded to post an inquiry on my wall about whether PP was the only entity that offered cancer screening – and that this backlash against Komen seemed to be more people angry at a pro-life agenda than anger at reduced cancer screenings.  A civil discussion (seriously) ensued from both sides.

But this whole episode served to highlight a couple things that I think can be learned about people’s feelings on these related matters.

  1. Many thoughts are illogical — One of the commenters was outraged at how this affects women’s health and that it was hypocritical of a women’s health organization to remove funding.  She then proceeded to imply that she would be removing her support from Komen —- thus removing funding for women’s health.  I don’t think it’s a stretch to say that Komen put women’s health, specifically breast cancer awareness, on the map.  According to trusted resources (wink wink, wiki!!), since its inception in 1982 Komen has raised and invested $2 billion towards research, education, and health services.  The amount of funding they pulled was $700,000, and PP’s revenue last year was over $1 billion.  So it seems illogical, and disingenuous to try and state that 1) Planned Parenthood is really going to suffer, and 2) that Komen has hurt women’s health.
  2. Abortion infects everything — Whether you are pro-abortion (I refuse to use the word choice, I consider myself being reserved for not saying pro-death) or pro-life it is impossible to deny that anytime this subject comes up it causes emotions to boil and inflated feelings to emerge from both sides.  As I said in the post above, many people want to paint this as a critique of Komen’s irresponsibility towards breast cancer screening.  But that is false I think.  In addition to the reasons above, there hasn’t even been enough time to determine if Komen reapportions that money to another organization that performs screening as well.  Let’s even suppose that Komen had simultaneously (and now I wish they had) announced just such an organization as the recipient of the money.  Do you think there would still be no uproar?  I believe there still would have been.  Because at the core of this is the fact that Komen’s actions do seem to stem from internal affiliation with the pro-life movement, or at least succumbing to pressure of pro-life groups (though I still haven’t heard what that pressure was).  So while this is ostensibly about cancer – it is actually about abortion.  The issue that infects everything.
  3. Finances don’t really matter only agendas — There are a lot of dollars floating around this story.  Grant money de-funded, annual revenue for the different organizations, money that Komen will lose from potential donor loss, and $650,000 raised by PP in the hours following the news.  But what remains true is that neither organization is going to stop doing the work they are doing.  We’ve already identified that $700,000 won’t hurt the billion-dollar Planned Parenthood, and though Komen may in fact lose some support, they will not stop trying to follow a mission of ending breast cancer.  So what has all this hoopla done?  Just added a news story for people to get worked up about, and to attack each other.  What if the pro-life gang had said, “dang, it’s just $700,000 let’s just let them have it but we won’t renew in the future”?  And what if pro-abortion folks had just shrugged and said, “stupid pro-lifers – I’m going to go donate some money to Planned Parenthood now”?  We could have avoided this – but no, agendas must be met.
  4. Both sides have idiots — As is obvious I am rabidly pro-life, but when I hear and read about people protesting at abortion clinics and telling the girls and women they are going to hell I want to punch them in the face.  No – I want to hurt them.  Not very Christian of me, I know.  But when I hear people rage against the horrible religious right, when they proclaim this is a woman’s choice and my opinion does not matter, or when Planned Parenthood staff are caught covering abuse, or encouraging teen abortions I want to punch them too.  No – I want to hurt them.

Those are my thoughts.

Oh wait – one more.  If this is not a life, then why does it need to be removed?

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One of my biggest problems with our existing health care system is that it relies on employers to provide coverage. By doing so, it complicates matters for the unemployed or for people whose employers can’t afford to offer such a benefit.

I feel it also has a profound impact on small businesses, and I like small businesses. Big businesses have huge advantages for providing health care to their employees, not only because they have more capital with which to provide it, but also because they can purchase it at a lower cost due to the quantities they’re buying. Their larger pool of employees also shields them from sharp spikes in premium costs due to individual employee sicknesses, pre-existing conditions, advanced age, and other health liabilities.

For me, the only complete solution for me is to remove health care from employment entirely. It’s actually one of the points McCain made in his campaign for president. He argued that the insurance policy needs to stay with the person, not with the job, and I agreed.

But that didn’t happen in this law, and it probably won’t because big business lobbies fought to keep health insurance in their control. I’m not sure why, but I can guess that it actually saves them money. A big business can provide employees not only with some money toward their premiums, but because of their purchasing power, also with a price on the policy that employees could not achieve individually. In other words, the insurance policy is more valuable than money for the employee and cheaper than money for the employer. But that only works if the company is big enough to command this purchasing power.

The new law by no means solves the problem for small businesses, but it does level the playing field a bit. For one, it provides a tax credit to small businesses who provide health care. The credit itself seems a bit limited, but it’s a nice gesture if nothing else. More importantly though, the law sets up exchanges that pool together many other small businesses allowing them to purchase health care with a similar economy of scale that big businesses enjoy.

I think this approach has promise. It’s uses the natural forces of free enterprise without imposing burdensome mandates. It doesn’t involve one person subsidizing another person’s coverage, and it doesn’t penalize anybody. I’m not sure if big businesses will like the increased competition, but I’m personally not worried about that.

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One of the few immediate effects of the health care bill is the elimination of exclusions for children with pre-existing conditions, and I couldn’t be happier about that.

Right now, my daughter is receiving a specialized treatment that involves trips to a specialist and one shot a month. Off hand, I’m not sure how much the office visits cost, but we do know that the shots are $1500 a piece. There are also several expensive tests and lab work that go along with the treatment. Under most existing plans, if I were to lose my job, and therefore have to switch plans, we would lose coverage for this treatment permanently.

My daughter’s condition is no fault of her own. It’s not from smoking, overeating, from sky diving, or anything else that she has chosen. She was born with it. Lucky for us, it’s not life-threatening. However, a life threatening disease would fall under the same category.

I am very thankful to the Democrats for fixing this problem, and I think the Republicans should look a little more closely at who they will hurt in their attempts to dismantle this bill.

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As of today, House Democrats are close to a vote on the Senate Health Care Bill, which they intend to pass and then modify through a budget process that will circumvent Republicans.

I think we can all agree that it’s sad if not demoralizing that something so important as health care should be put through a process so ridiculous as this, and that the result could be as ineffectual as the Senate bill promises.

The bill’s lack of popularity comes from all sides of the political spectrum. Some fear it imposes too much government while others fear that keeping health care in the private sector accomplishes nothing. Abortion rights advocates claim that it could prevent health insurance companies from providing abortion coverage, while abortion rights opponents claim that the bill could provide tax-payer money for abortions. Some people worry that it doesn’t tax “cadillac” health plans enough to pay for itself, and people with “cadillac” health plans lament a possible new tax.

The health insurance industry worries that the penalties for not buying insurance are not substantial enough, others doubt the plausibility of a mandate with no public option to assure that all people can afford it, and others still simply reject the idea of a government mandate for buying anything. Many people see little in the bill to reduce health costs, and most people question the effectiveness of a bill that lacks bipartisan support.

I’m definitely disappointed. Health care reform is so important. Our system leaves out millions of people, and millions others remain less protected than they think, which exacerbates the misery of a health emergency by tacking on a devastating  financial one. The way the system is presently designed, the health insurance industry is the least motivated to provide for people who need the coverage the most. That’s a pretty backward economy if you ask me. Furthermore, the system is channeled through employment benefit packages, which makes lay-offs so much more troublesome, and which simply isn’t consistent with today’s transient workplace.

I’m disappointed in both political parties. The Republicans have been despicable. It is very clear that they see a distinct political advantage in blocking this effort, and they’ve put that goal ahead of the needs of people. Most disturbingly, they continuously repeat lies and mistruths about the legislation that have distorted perceptions and derailed the process. I would like to hear just one Republican tell the truth on this subject. I would like to hear one Republican stand up and say something like this:

“I don’t support this plan for good reasons, but I reject the lies that my party is spreading. Sarah Palin lied about death panels. She was referring to end of life counseling. They are not death panels, and she, herself, supported them in the past. This plan is not a socialist takeover of health care. It’s too much government, yes, but the government will not takeover the companies. Furthermore, there’s nothing in the plan to limit your choice of doctor or to prevent you from keeping the coverage you have now. It’s still a bad plan, and here’s why…”

I would deeply respect such a republican, but as of now, no such republican exists.

Republicans claim that they do want reform and they’ve been bringing stellar ideas to the table, but those horrible democrats won’t let them contribute. I have real difficulty believing this. Republicans had control of executive branch for 8 years and full majorities in the house and senate for six of those years. During that time, the best they did for health care was pass a perscription drug plan that failed to help anybody in any way. Instead, they preserved the status quo, while my health insurance premium tripled and my co-pay quadrupled.

I’m also disappointed with democrats. For one, they are up against air-tight voting discipline from the republicans. In general, I’m opposed to such tactics, but health care is too important. The democrats need to have discipline of their own in this case. Their fragmentation on this issue has not only jeopardized the bill itself, but it’s also caused the public to lose confidence in their efforts.

More problematic for me is their inability to achieve bipartisan support. They say that Republicans won’t come to the table, while Republicans say that democrats won’t let them come to the table, and there’s really no way for us to know the truth on this. My guess is that it’s both. What we do know, however, is that tort reform did not make it into the bill at all, and that’s inexcusable. This issues is one of the major problems affecting health care that needs to be addressed, and it should have been a starting point for building consensus with Republicans. There also should have been no chance that abortion could enter into this debate. Allowing any language that could possibly lead to tax-payer money funding abortions is not only unacceptable, but politically stupid. My belief is that democrats wanted to do this without republicans, which means that they would do it without half the country, and that simply can’t work.

My concern on this issue isn’t just based on health care. This process we’ve been through makes me seriously question our country’s ability to tackle any problem in our future. Republicans will have power again soon, and democrats will use the same tactics against them, and possibly worse. Imagine the consequences of such a spiral.

On the question of health care reform, I would like all people involved in this debate start with one simple question: should every American citizen have health coverage? I’d like a yes or no answer on this. If the answer is no, then explain who should be left out an on what criteria. If the answer is yes, then I’d like to know how that can work for our country. I believe that clarity on this question will build common ground and lead to much better problem solving on the issue.

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Before 2001 I had very few views on anything.  9/11 did not change that… getting out of college and working full-time did.  I was daily interacting with older people, and was working for a very smart and politically-minded writer, who’s legal scripts left me searching for what on earth he was talking about.  It was then that I started paying attention to current events, and reading about economics, business, history, education and so forth.  And the more I read and studied and discussed, the more I started to become opinionated and attached to certain philosophies.  It was then I also realized that, with few extreme exceptions, most political philosophies and theories are never enacted completely and freely to see if they work.  One word stands in their way… bipartisanship.

That hallowed word of camaraderie; working together under forced compromise.  Crossing the aisle.  Meeting in the middle.  Whatever you wished to call it, politics is all about it, and I think it causes is something that is less than it’s combined parts.  Or worse-

Health Care Reform's Ultimate End?

I am not against compromise.  It has strong value and is an incredible trait to be able to exercise… especially with spouses.  But I am more of a fan of ideas, and ideas need to be able to run their course to see if they are good or bad.  We would never have known that pure country music is so bad, except that it was released in it’s original form, instead of the more digestible alt-country format of Wilco, Band of Horses, and others.  All kidding aside, I do think that we stand a better chance of needed change and reform (if it is in fact needed) if we allow ideas to work.  And I’m not for it, just out of boredom.

Washington, D.C. is supposed to house our leaders.  But we have lost our leaders because they are all bent on reelection and must watch lest they try something and it fails.  Better to form a bipartisan coalition and we can all blame the other side if it backfires.  Well guess what?  I am willing to give your idea an unobstructed chance at health care, if you let my idea for social security go untouched.  You can have agriculture if you give me education.  We’ll check back in at the pre-appointed time to see the results.  If your idea has been a success then we all benefit.  If it hasn’t, then we try the other one… and so on, and so forth.  Done!

Problem is that there are still too many ancillary arguments to be made.  “My education idea didn’t work because it needs to be combined with an elimination of social welfare benefits and that’s your area”.  “Your farm subsidies are messing up my commerce plans!”  Plus there is the always relied upon threat of our nation’s demise.  “The Stimulus Bill is going to bankrupt the nation and we’ll never recover!”  “Allowing School Vouchers would immediately disenfranchise children all across the world!!!”  Also, how do we determine what results are considered a success?  That’s a political nightmare in itself.

But the same excuses are made within bipartisanship, so at least here we would have some more information to work with… again, theoretically.  This is all semantic arguing… neither party is likely to let the other run hog-wild with an unfettered agenda.  What if, heaven forbid, it works and voters switch allegiances?  Well, I guess that’s where the rubber meets the road.  If you think your ideas truly are the best, then you need to let them be tested.  And if you think the other guys ideas are the worst, let them be tested to prove it.  It’s what happens in laboratories, writers’ rooms, jam sessions, and anywhere else ideas are floated.  Except it seems in our state and national capitals.

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This article that I read today by Michael Tanner clearly and eloquently states the case that I’ve been feebly trying to make for a long time – the reason health care is so expensive is because consumers do not, by and large, pay for it.

When Jana and I first got married I was self-employed (as a private math tutor) and, as such, did not have any employer-provided health insurance.  At the suggestion of my brother Mike (known to CAI as Michael) I purchased a high deductible health insurance policy and began saving money to insulate ourselves from sudden, unexpected medical costs (I think the deductible was a couple thousand dollars, so the policy was only intended to be used for catastrophe).  I remember during that time how, the few times we did need medical services, it was so strange to actually pay for service with cash.  We were surprised to learn that deals could be found with a little searching- for example we found a clinic in Seal Beach that had a completely different price structure for those paying with cash, and it actually wasn’t terribly expensive (I had never actually seen prices displayed in a doctor’s office before).  During that time we avoided the doctor as much as possible, and when we finally decided to go, we shopped around and found a deal.  All of this language is of course very foreign to the topic of health care, and that’s part of the problem.

When I eventually got hired full time as a teacher I got a very generous health care plan, and we ceased to look around for deals.  I remember, in fact, discussing my new benefits with a co-worker who encouraged me to “start taking advantage.”  The new plan didn’t include dental benefits for Jana though, so we continued our frugal ways in that department.

The point is pretty straightforward – the consumer is best suited to ration goods and services when normal price mechanisms are in place.  When we (and I’m speaking about myself here) don’t feel the cost of purchases, we have little incentive to restrain what we purchase.  More consumers purchasing more freely creates more demand, thus higher prices (as was the case with the housing boom and interest-only loans – guilty as charged again).

I’m not suggesting any particular policy here, but I do wish that this simple economic reality would at least make it into the discussion from time to time, rather than the continual demagogue of insurance companies and health care providers, who are only operating according the to same free-market principles that we expect from other sectors.  I have met doctors and people in the insurance industry, and they are no more evil or greedy on average than the rest of us in my experience.

One more anecdote: One time I got some metal debris in my eye and went to the emergency room.  The doctor put a drop of numb juice (I think that’s the medical term for it) in my eye, told me the debris was now out, and gave me some mild pain medication.  To make a long story short, the debris was not out of my eye and was only removed once I visited an eye doctor a few days later.  Nonetheless, the bill for this emergency room visit was over $700.  To make another long story short, I offered to pay the bill in cash if they would bring down the price.  The hospital initially declined my request, but I eventually spoke to a manager at the hospital who apologized and explained that I never should have seen that price.  As he explained it, that price is what they send to the insurance company, because they expect the insurance company to come back and low ball, so they have to start high.  Or some really convoluted scheme along those lines.  He cut the bill in half for me.

In this case I wish I would have rationed myself, and waited to get an appointment with an eye doctor (now I know) but this story clearly demonstrates just how convoluted the health insurance process is, and how costs go up because of it.  If more people were paying cash for medical service we would have a lot more (self) rationing and a lot less wasteful red tape.  Again, I don’t know what kind of legislation (if any) could create this scenario, but I wish it would get discussed more.

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